Achilles Tendinopathy

The Achilles tendon is a thick band of tissue located at the back of the ankle. It connects the calf muscles (the gastrocnemius and soleus) to the heel. Flexing your calf muscles causes the Achilles tendon to pull on your heel. This allows you to walk, run, jump and stand on your toes (Hoffman 2014). The Achilles tendon is one of the largest and strongest tendons in the human body. However it’s also very vulnerable to injury because of its low blood supply and a lot of tension is placed on it.

One of the most common conditions that affects the Achilles tendon is called Achilles tendinopathy. This condition causes pain, stiffness and swelling of the Achilles tendon. It is more common in active people but can affect less active people (NICE 2014). It affects more than 150,000 people in the UK every year (Kearney 2013).

Achilles tendinopathy is thought to occur when the normal tendon healing response fails, when tendonitis has become chronic (tissues have enlarged in the tendon). Risk factors for Achilles tendinopathy include overuse or strenuous activity such as running and jumping, ageing can cause the tendon to degenerate. Biomechanical factors such as high arches, ankle instability as well as poor footwear and poor training techniques can also lead to Achilles tendinopathy. In the clinic we will breakdown the process of what is causing this, individual to each client.

The main symptoms of Achilles tendinopathy are pain and stiffness that gets gradually worse, usually at the back of your ankle. There will also be swelling and your tendon might feel tender to touch. Pain and stiffness may be particularly worse in the morning or after exercise. If you feel a sudden sharp pain in your heel or calf, which quickly becomes swollen, bruised and sore, you may have torn a tendon. This is called an Achilles tendon rupture. You should get urgent medical attention if this happens (Davies 2019).

If you suspect you have Achilles tendinopathy you should see a Physiotherapist. Our Physiotherapist’s will clinically assess what stage you are at:
– Reactive Tendinopathy
– Tendon Disrepair
– Degenerative Tendinopathy / Late Disrepair

They will show you how to strengthen/load your Achilles tendon appropriately by giving you exercises to do every other day. These will include ‘isometric’ exercises, then ‘concentrics’ and then onto ‘eccentric exercises’.
These exercises will help reduce pain and enable your tendon work better. A physiotherapist can also help you correct problems with your posture and the biomechanics as this will help prevent the injury reoccurring (Davies 2019).

Achilles tendinopathy becomes more resistant to treatment if it is not recognized and managed at an early stage (reactive tendinopathy). Remember Tendon’s hate change so where possible, keep doing the training load you were before, don’t stop everything completely as you will then aggravate the tendon going back into training. Using a cross training or bike instead of running for example. If you come to our Physiotherapists in the late disrepair or degenerative stage (some of the tissues in the tendon are dead), we will cover isometrics, spacing of training (rest days), strength work and long term management.

If you suspect you have Achilles Tendinopathy, get in touch and book in for an assessment with one of our Physiotherapists. 🤓

References
Asplund, C. and Best, T. (2013) Achilles tendon disorders. BMJ. Vol. 346, pp.1262.

Davies, S. 2019. Achilles Tendonopathy [online]. BUPA. available from: https://www.bupa.co.uk/…/muscles-bone…/achilles-tendinopathy.

Hoffman, M. 2014. Human Anatomy [Online]. Available from: https://www.webmd.com/fitne…/picture-of-the-achilles-tendon….

Kearney, R., Parsons, N. and Costa, M. 2013 Achilles tendinopathy management: a pilot randomised controlled trial comparing platelet-richplasma injection with an eccentric loading programme. Bone and Joint Research. Vol. 2(10), pp. 227-232.

NICE. 2014. Achilles tendinopathy [online]. NICE. Available from: https://cks.nice.org.uk/achilles-tendinopathy#!topicSummary.

Hobrough, P. 2019. Talk on Tendons, COPA event, London. https://www.physioandtherapy.co.uk/